WellFirst Health EDI Claims

WellFirst Health EDI Claims Acknowledgement Process WellFirst Health provides acknowledgment of electronic claim submissions through the 277 Claims Acknowledgement (277CA) transaction or the Confirmation Reports Portal. If a provider’s office enrolls to receive 277CA responses, a response file will be generated for each electronic 837claim file WellFirst Health receives. Confirmation reports show all claims accepted in Read More →

EDI Claims Processing

WellFirst EDI Claims Processing Guidelines WellFirst Health requires providers to use the correct and complete member number. Families share the first nine digits of their subscriber number. The remaining two digits signify the individual member (i.e. spouse, dependents, etc.). Using the correct member numbers on the claims submitted to WellFirst Health will help to ensure Read More →

wellfirst edi

Electronic Data Interchange (EDI) For Providers WellFirst Health WellFirst Health offers HIPAA-compliant electronic transactions to providers to meet consistent documentation, handling and privacy standards as well as for efficiency. Eligibility and Benefit Inquiry and Response (270/271) The most timely and accurate way to confirm a member’s benefits and coverage amounts is to submit an eligibility Read More →

Medical EDI

Medical EDI Implementation Guide (Electronic Medical Report Submission) Medical EDI is the electronic submission of medical bills by all healthcare providers. The Medical EDI Team assists electronic medical submitters with the management of electronic medical filings. To allow comparison benchmarking among the insurance industry, the team generates monthly report cards that denote the primary reasons for Read More →

HIPAA Compliant 837 Claim

HIPAA Compliant 837 Claim Audit (SummaCare) When the HIPAA Compliant 837 claims file is submitted it is checked for ASC X12 syntax and HIPAA compliance errors. When the compliance check is complete, a 997 Acknowledgement will be sent to the trading partner informing them if the file has been accepted or rejected. If multiple transaction sets (ST-SE) are Read More →

837 Institutional Health Care Claim

837 Institutional Health Care Claim Mapping Guidelines (SummaCare) After the claim transmissions have passed Implementation Guide compliance checks for acceptance into the SummaCare system, business edits, specific to SummaCare, are then applied to the incoming HIPAA compliant claims. The business edits include security validation and the verification of proprietary business requirements. Guidelines are used in conjunction with the ASC X12N Read More →

Facilities in a Health System

Facilities in a Health System: SummaCare Explained If you are a facility in a Health System and your checks are issued to the Parent Company, you should use the NPI number specifically assigned to your facility. If you use another facility’s NPI number under the Parent Company, it will result in the check being issued correctly to the Read More →

EDI Claims Processing

EDI Claims Processing Guidelines (SummaCare) Any claim submitted that contains more than 85 service lines will be split into two claims by SummaCare for payment. When submitting an 837 transaction for members after billing their other insurance sources, the other payer’s adjudication details that were provided on the 835 Remittance transaction must be supplied to SummaCare. The Read More →

Sending Electronic Claims

Basic Guides For Sending Electronic Claims To SummaCare SummaCare accepts all ASCX12 compliant transactions, the HIPAA Implementation Guides allow for some discretion in applying the regulations to existing business practices. Understanding SummaCare business practices may expedite claims processing for trading partners as they exchange EDI transactions with SummaCare. Electronics submission of claims will follow these guidelines: Claims currently filed Read More →

HIPAA EDI 7030 Standard

Development HIPAA EDI 7030 Standard Training EDI Academy started developing a curriculum for the Health Care HIPAA EDI 7030 Standard. While there is still no go-live date for the 7030, we have been busy creating gap analysis courses between 5010 and 7030.  HIPAA EDI Webinar 420: 7030-5010 Migration Introduction will be the first webinar of Read More →